Pediatric Trauma Considerations Flashcards

The Pediatric Assessment Triangle (PAT) is a rapid assessment tool used to form a general impression of a sick child. Which of the following are the three components of the PAT?

Answer: Appearance, Work of Breathing, Circulation to Skin

The Pediatric Assessment Triangle (PAT) consists of three key observational components: Appearance (evaluating tone, interactiveness, consolability, look/gaze, and speech/cry), Work of Breathing (assessing for abnormal sounds, positioning, and retractions), and Circulation to Skin (checking for pallor, mottling, or cyanosis). This tool allows for a rapid 'from the doorway' evaluation without touching the patient.

When positioning an infant trauma patient for airway management, what modification is often necessary to achieve a neutral airway alignment?

Answer: Placing padding under the shoulders and torso.

Infants and young children have a proportionally large occiput (back of the head), which causes passive neck flexion when they are laid supine. To counteract this and achieve a neutral or 'sniffing' position that properly aligns the airway axes, padding should be placed under the shoulders and upper torso.

A 5-year-old child weighing 20 kg is in decompensated hemorrhagic shock following blunt abdominal trauma. According to ITLS guidelines, what is the correct initial isotonic crystalloid fluid bolus?

Answer: A 400 mL bolus (20 mL/kg) administered as quickly as possible.

The standard initial fluid bolus for a pediatric trauma patient in shock is 20 mL/kg of an isotonic crystalloid solution (like Normal Saline or Lactated Ringer's). For a 20 kg child, this calculates to 20 kg * 20 mL/kg = 400 mL. This bolus should be administered rapidly.

Which of the following best describes a key physiological difference in how children compensate for hemorrhagic shock compared to adults?

Answer: Children can maintain a normal blood pressure despite significant blood loss.

Children have very effective compensatory mechanisms, including intense vasoconstriction and an increased heart rate. This allows them to maintain a normal systolic blood pressure until they have lost a substantial percentage of their circulating blood volume (up to 45%). Hypotension is therefore a late and ominous sign of decompensated shock in a child. Tachycardia is the earliest sign.

A 6-year-old pedestrian is struck by a motor vehicle. The provider should maintain a high index of suspicion for Waddell's Triad, which is a classic pattern of injuries consisting of:

Answer: Femur fracture, intra-abdominal/thoracic injury, and contralateral head injury.

Waddell's Triad describes the three-part injury pattern commonly seen in pediatric pedestrian-versus-vehicle collisions. The sequence involves: 1) The car's bumper striking the femur; 2) The child's torso striking the hood or fender, causing thoracic or abdominal injuries; and 3) The child being thrown to the ground, resulting in a head injury on the opposite side of the initial impact.

A 7-year-old falls off his bicycle, striking the handlebar directly into his upper abdomen. He is now tachycardic, pale, and has significant epigastric tenderness. In pediatric blunt abdominal trauma, which solid organ is most frequently injured?

Answer: Spleen

In pediatric blunt abdominal trauma, the solid organs are most at risk. The spleen and liver are the most commonly injured organs due to their size and location. The spleen is particularly vulnerable because of its rich blood supply and relatively unprotected position in the left upper quadrant.